Modi Vikash K, Visaya Jiovani M, Ward Robert F
Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical College, New York, New York.
Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology-Head & Neck Surgery, John Hopkins Medical School, Baltimore, Maryland, U.S.A.
Laryngoscope. 2015 Sep;125 Suppl 6:S1-11. doi: 10.1002/lary.25425. Epub 2015 Jul 7.
OBJECTIVE/HYPOTHESIS: To examine the short- and long-term histopathologic changes that occur in the subglottis in response to airway balloon dilation (ABD) with different balloon diameters and inflation pressures.
Prospective animal study using forty-two 8-month old New Zealand white rabbits at an academic animal research facility.
Thirty-nine live New Zealand rabbits underwent a single ABD with diameters ranging from 6.0 mm to 10.0 mm and with pressures between 5.0 atmospheres (atm) to 15.0 atm. Animals were euthanized on postoperative days (POD) 1, 7, and 30, and the histopathological changes of the subglottis were examined. Three rabbits served as controls and underwent no ABD.
The subglottic airway diameter of all specimens measured 5.4 mm. When examining the fracture rate by balloon diameter, we found the following: 0 of 6 (0%) at 6 mm, 0 of 9 (0%) at 7 mm, 6 of 9 (67%) at 8 mm, 8 of 9 (89%) at 9 mm, and 6 of 6 (100%) at 10 mm. There was a statistically significant relationship with the rate of cricoid fracture as balloon diameter increased (P < .0001). All fractures occurred at the anterior cricoid lamina. On POD 1, we found mild ulceration in 5 of 6 (83%) using a 6-mm or 7-mm balloon and in 0 of 6 (0%) using an 8-mm, 9-mm, or 10-mm balloon; and moderate/severe ulceration in 1 of 6 (16.67%) using a 6-mm or 7-mm balloon and in 11 of 11 (100%) using an 8-mm, 9-mm, or 10-mm balloon (P < .0001). Also on POD 1, we found mild edema in 6 of 6 (100%) using a 6-mm or 7-mm balloon and in 5 of 11 (45%) using an 8-mm, 9-mm, or 10-mm balloon; and moderate/severe edema in 0 of 6 (0%) using a 6-mm/7-mm balloon and in 6 of 11 (55%) using an 8-mm, 9-mm, or 10-mm balloon (P =.048). On POD 7, we found fibroplasia in 5 of 6 (83%) using a 6-mm or 7-mm balloon and in 1 of 7 (14%) using an 8-mm, 9-mm, or 10-mm balloon; and moderate/severe fibroplasia in 1 of 6 (17%) using a 6-mm or 7-mm balloon and in 6 of 7 (86%) using an 8-mm, 9-mm, or 10-mm balloon (P =.029). Also on POD7, we found granulation tissue in 0 of 6 (0%) using a 6-mm or 7-mm balloon and in 5 of 7 (71%) using an 8-mm, 9-mm, or 10-mm balloon (P = .021). On POD 30, we found no fibrosis in 0 of 3 (0%) using a 7-mm balloon, mild fibrosis in 1 of 6 (16.67%), and moderate/severe fibrosis in 5 of 6 (83%) using an 8-mm or 9-mm balloon (P = .048). Also on POD 30, we found the mean subglottic cross-sectional luminal area was 23.79 mm(2) with a 7-mm balloon and 29.28 mm(2) with an 8-mm or 9-mm balloon (P = .019). Inflation pressure alone had no correlation with mucosal injury or probability of cricoid fracture.
Airway balloon dilation with balloon diameters that exceeded the airway diameter by 2.6 mm was associated with cricoid fractures. All cricoid fractures localized to the anterior cricoid lamina. Balloon diameters larger than the airway diameter by 2.6 mm resulted in a larger subglottic cross-sectional luminal area on POD 30. Airway balloon dilation with balloon diameters that could generate a cricoid fracture created more mucosal injury on POD 0, 1, and 7 than smaller balloon diameters. The histopathological effects of airway balloon dilation observed on POD 0, 1, and 7 resolved by POD 30. When balloon diameter is kept constant, inflation pressure alone had no correlation with mucosal injury or probability of cricoid fracture.
NA (animal study). Laryngoscope, 125:S1-S11, 2015.
目的/假设：研究不同球囊直径和充气压力的气道球囊扩张术（ABD）对声门下组织造成的短期和长期组织病理学变化。
在一家学术性动物研究机构，对42只8月龄新西兰白兔进行前瞻性动物研究。
39只活的新西兰兔接受了单次ABD，球囊直径范围为6.0毫米至10.0毫米，压力在5.0个大气压（atm）至15.0 atm之间。在术后第1天、第7天和第30天对动物实施安乐死，并检查声门下的组织病理学变化。3只兔子作为对照，未接受ABD。
所有标本的声门下气道直径均为5.4毫米。按球囊直径检查骨折率时，我们发现：6毫米时6只中有0只（0%），7毫米时9只中有0只（0%），8毫米时9只中有6只（67%），9毫米时9只中有8只（89%），10毫米时6只中有6只（100%）。随着球囊直径增加，环状软骨骨折率存在统计学显著关系（P < .0001）。所有骨折均发生在环状软骨前板。在术后第1天，使用6毫米或7毫米球囊的6只中有5只（83%）出现轻度溃疡，使用8毫米、9毫米或10毫米球囊的6只中无1只出现溃疡（0%）；使用6毫米或7毫米球囊的6只中有1只（16.67%）出现中度/重度溃疡，使用8毫米、9毫米或10毫米球囊的11只中有11只（100%）出现中度/重度溃疡（P < .0001）。同样在术后第1天，使用6毫米或7毫米球囊的6只中有6只（100%）出现轻度水肿，使用8毫米、9毫米或10毫米球囊的11只中有5只（45%）出现轻度水肿；使用6毫米/7毫米球囊的6只中无1只（0%）出现中度/重度水肿，使用8毫米、9毫米或10毫米球囊的11只中有6只（55%）出现中度/重度水肿（P =.048）。在术后第7天，使用6毫米或7毫米球囊的6只中有5只（83%）出现纤维组织增生，使用8毫米、9毫米或10毫米球囊的7只中有1只（14%）出现纤维组织增生；使用6毫米或7毫米球囊的6只中有1只（17%）出现中度/重度纤维组织增生，使用8毫米、9毫米或10毫米球囊的7只中有6只（86%）出现中度/重度纤维组织增生（P =.029）。同样在术后第7天，使用6毫米或7毫米球囊的6只中无1只（0%）出现肉芽组织，使用8毫米、9毫米或10毫米球囊的7只中有5只（71%）出现肉芽组织（P = .021）。在术后第30天，使用7毫米球囊的3只中无1只（0%）出现纤维化，使用8毫米或9毫米球囊的6只中有1只（16.67%）出现轻度纤维化，6只中有5只（83%）出现中度/重度纤维化（P = .048）。同样在术后第30天，使用7毫米球囊时声门下平均横截面积为23.79平方毫米，使用8毫米或9毫米球囊时为29.28平方毫米（P = .019）。仅充气压力与黏膜损伤或环状软骨骨折概率无相关性。
球囊直径超过气道直径2.6毫米的气道球囊扩张术与环状软骨骨折相关。所有环状软骨骨折均局限于环状软骨前板。球囊直径比气道直径大2.6毫米在术后第30天导致更大的声门下横截面积。与较小球囊直径相比，能导致环状软骨骨折的球囊直径在术后第0天、第1天和第7天造成更多黏膜损伤。在术后第0天、第1天和第7天观察到的气道球囊扩张术的组织病理学效应在术后第30天消失。当球囊直径保持恒定时，仅充气压力与黏膜损伤或环状软骨骨折概率无相关性。
NA（动物研究）。《喉镜》，2015年，第125卷：S1 - S11。
